Clinical Subtypes in Children with Attention-Deficit Hyperactivity Disorder According to Their Child Behavior Checklist Profile

Daisuke Katsuki; Hiroshi Yamashita; Kenichi Yamane; Shigenobu Kanba; Keiko Yoshida

doi:10.1007/s10578-020-00977-8

Clinical Subtypes in Children with Attention-Deficit Hyperactivity Disorder According to Their Child Behavior Checklist Profile

Child Psychiatry Hum Dev. 2020 Dec;51(6):969-977. doi: 10.1007/s10578-020-00977-8.

Authors

Daisuke Katsuki^{1

2}, Hiroshi Yamashita³, Kenichi Yamane³, Shigenobu Kanba^{4

5}, Keiko Yoshida^{5

6}

Affiliations

¹ Department of Child Psychiatry, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan. dkatsuki@npsych.med.kyushu-u.ac.jp.
² Department of Neuropsychiatry, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashiku, Fukuoka City, Fukuoka, 8128582, Japan. dkatsuki@npsych.med.kyushu-u.ac.jp.
³ Department of Child Psychiatry, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
⁴ Japan Depression Center, Tokyo, Japan.
⁵ Department of Neuropsychiatry, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashiku, Fukuoka City, Fukuoka, 8128582, Japan.
⁶ Iris Psychiatric Clinic, Fukuoka, Japan.

PMID: 32166459
DOI: 10.1007/s10578-020-00977-8

Abstract

This study sought to identify subgroups of attention-deficit hyperactivity disorder (ADHD) defined by specific patterns of emotional and behavioral symptoms according to the parent-rated Child Behavior Checklist (CBCL). Our clinical sample comprised 314 children (aged 4 to 15 years) diagnosed with ADHD according to the DSM-5. In addition, comorbid psychiatric disorders, general functioning, and medication status were assessed. Cluster analysis was performed on the CBCL syndrome subscales and yielded a solution with four distinct subgroups. The "High internalizing/externalizing" group displayed an overlap between internalizing and externalizing problems in the CBCL profile. In addition, the "High internalizing/externalizing" group revealed a high rate of comorbid autism spectrum disorder and elevated autistic traits. The "Inattention and internalizing" group revealed a high rate of the predominantly inattentive presentation according to ADHD specifier from the DSM-5. The "Aggression and externalizing" group revealed a high rate of comorbid oppositional defiant disorder and conduct disorder. The "Less psychopathology" group scored low on all syndrome scales. Children with ADHD were subdivided into four distinct subgroups characterized by psychopathological patterns, with and without internalizing and externalizing problems. The overlap between internalizing and externalizing problems may be mediated with emotional dysregulation and associated neurobiological bases.

Keywords: Attention-deficit hyperactivity disorder; Child behavior checklist; Classification; Cluster analysis; Comorbidity.

MeSH terms

Adolescent
Aggression / psychology
Attention Deficit Disorder with Hyperactivity / diagnosis*
Attention Deficit Disorder with Hyperactivity / psychology
Attention Deficit and Disruptive Behavior Disorders / diagnosis
Attention Deficit and Disruptive Behavior Disorders / psychology
Autism Spectrum Disorder / diagnosis
Autism Spectrum Disorder / psychology
Checklist / statistics & numerical data*
Child
Child Behavior Disorders / diagnosis*
Child Behavior Disorders / psychology
Child, Preschool
Comorbidity
Conduct Disorder / diagnosis
Conduct Disorder / psychology
Diagnostic and Statistical Manual of Mental Disorders
Female
Humans
Male
Parenting / psychology
Psychopathology